Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Neuropathic pain refers to pain that originates from pathology of the nervous system. Common causes of neuropathic pain are diabetes mellitus, reactivation of herpes zoster, nerve compression or radiculopathy, alcohol, chemotherapy or abuse of some drugs, and trigeminal neuralgia. Specific symptoms of neuropathic pain are mechanical allodynia and cold hyperalgesia. Drugs to treat neuropathic pain can be divided into adjuvant analgesics (antidepressants and anticonvulsants), opioids and topical agents. The use of multiple drug therapies is common in practice. Despite considerable increase in the number of randomized placebo-controlled trials in neuropathic pain in the last few years, the medical treatment of neuropathic pain is still far from being satisfactory, with less than half of patients achieving significant benefit with any pharmacological drug.Neuropatska bol nastaje kao posljedica disfunkcije perifernog ili središnjeg živčanog sustava. Najčešći uzroci neuropatske boli su dijabetes melitus, reaktivacija infekcije herpes zoster, kompresija živaca ili radikulopatija, pretjerana konzumacija alkohola, kemoterapija ili zlouporaba lijekova te neuralgija trigeminusa. Specifični simptomi neuropatske boli su mehanička alodinija i hladna hiperalgezija. U liječenju neuropatske boli rabi se nekoliko skupina lijekova. U prvu skupinu spadaju adjuvantni lijekovi, a to su antidepresivi i antiepileptici, opioidi i lokalna sredstva. U praksi se najčešće rabi kombinacija dviju ili vise vrsta lijekova. Unatoč brojnim randomiziranim, placebom kontroliranim studijama na području neuropatske boli medikamentno liječenje neuropatske boli jos uvijek nije zadovoljavajuće, te se zadovoljavajuća analgezija postiže u samo 50% bolesnika s neuropatskom boli
